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Get Ballad Health Application For Financial Assistance 2020-2024
, Please provide all documentation listed below that applies. Sign and return to the address listed below. Documentation should include all family members in the household. Required Documentation (*Do not send originals * Please use black ink) Last two years of Federal Tax Returns are required. If you did not file taxes, you must provide a 4506-T form from the IRS. W-2 and last 3 pay stubs. If you are drawing Social Security, Disability, or a Military Pension, you will need to pro.
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Dividends FAQ
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To qualify for HCAP, patients will be asked to complete a simple form and provide income and resource verification information. Proof of Ohio residency may be required. Patients may be required to apply for governmental assistance programs, if Financial Counseling deems this appropriate.
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Contact Us For more information about charity care and medical financial assistance, please contact customer service at (614) 566.1505.
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Healthcare Financial Assistance provides assistance to individuals who are uninsured for emergent medical and medically necessary healthcare. Patients who wish to apply for this program must be an Ohio resident and have income at or below 250% of the established annual federal poverty guide.
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How do I apply for Ohio Medicaid? For additional application information, visit the Get Coverage page. Apply online for Ohio Medicaid. To learn more about the program, visit the Ohio Department of Medicaid home page. For more details, visit the Basic Health Program page, or call 1-800-324-8680.
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Our mission to honor those we serve by delivering the best possible care. Our vision to build a legacy of superior health by listening to and caring for those we serve.
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In Ohio, the DSH program is known as the Hospital Care Assurance Program, or HCAP. Payments under the HCAP program are supplemental to standard Medicaid hospital payments.
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It's your story. We're listening.
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